Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2017 Oct 10;70(15):1875-1886. doi: 10.1016/j.jacc.2017.08.010.
Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes.
CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT.
CHAMPION enrolled 550 patients with chronic HF regardless of left ventricular ejection fraction. A pre-specified sub-group analysis compared HF hospitalization and mortality rates between treatment and control groups in HFrEF patients (left ventricular ejection fraction ≤40%). Post hoc analyses in patients who tolerated GDMT were also performed. Hospitalizations and mortality were assessed using Andersen-Gill and Cox proportional hazards models.
In 456 patients with HFrEF, HF hospitalization rates were 28% lower in the treatment group than in the control group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.88; p = 0.0013), with a strong trend for 32% lower mortality (HR: 0.68; 95% CI: 0.45 to 1.02; p = 0.06). A 445-patient subset received at least 1 GDMT (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or beta-blocker) at baseline; these patients had 33% lower HF hospitalization rates (HR: 0.67; 95% CI: 0.54 to 0.82; p = 0.0002) and 47% lower mortality (HR: 0.63; 95% CI: 0.41 to 0.96, p = 0.0293) than controls. Compared with controls, patients receiving both components of optimal GDMT (n = 337) had 43% lower HF hospitalizations (HR: 0.57; 95% CI: 0.45 to 0.74; p < 0.0001) and 57% lower mortality (HR: 0.43; 95% CI: 0.24 to 0.76; p = 0.0026).
PA pressure-guided HF management reduces morbidity and mortality in patients with HFrEF on GDMT, underscoring the important synergy of addressing hemodynamic and neurohormonal targets of HF therapy. (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients [CHAMPION]; NCT00531661).
尽管指南指导的医学治疗（GDMT）的使用有所增加，但仍有一些射血分数降低的心力衰竭（HFrEF）患者存在住院和死亡的高风险。肺动脉（PA）压力的远程监测为临床医生提供了可操作的信息，以帮助进一步优化药物治疗并改善预后。
CHAMPION（CardioMEMS 心脏传感器可通过监测压力改善纽约心脏协会 III 类心力衰竭患者的预后试验）分析了基于 HFrEF 患者对 GDMT 的耐受性的 PA 压力指导的心力衰竭（HF）管理。
CHAMPION 纳入了 550 名慢性 HF 患者，无论左心室射血分数如何。一项预先指定的亚组分析比较了治疗组和对照组 HFrEF 患者（左心室射血分数≤40%）的 HF 住院率和死亡率。还对耐受 GDMT 的患者进行了事后分析。使用 Andersen-Gill 和 Cox 比例风险模型评估住院和死亡率。
在 456 名 HFrEF 患者中，治疗组的 HF 住院率比对照组低 28%（风险比 [HR]：0.72；95%置信区间 [CI]：0.59 至 0.88；p=0.0013），死亡率呈下降 32%的趋势（HR：0.68；95%CI：0.45 至 1.02；p=0.06）。一个包含 445 名患者的亚组在基线时至少接受了 1 种 GDMT（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或β受体阻滞剂）；这些患者的 HF 住院率降低了 33%（HR：0.67；95%CI：0.54 至 0.82；p=0.0002），死亡率降低了 47%（HR：0.63；95%CI：0.41 至 0.96，p=0.0293）。与对照组相比，接受 GDMT 最佳治疗方案（n=337）的患者 HF 住院率降低了 43%（HR：0.57；95%CI：0.45 至 0.74；p<0.0001），死亡率降低了 57%（HR：0.43；95%CI：0.24 至 0.76；p=0.0026）。
PA 压力指导的 HF 管理可降低 GDMT 治疗的 HFrEF 患者的发病率和死亡率，强调了针对 HF 治疗的血流动力学和神经激素目标的重要协同作用。（CardioMEMS 心脏传感器可通过监测压力改善纽约心脏协会 III 类心力衰竭患者的预后[CHAMPION]；NCT00531661）。
